Which information is the nurse likely to find in the clinical implications section of an article

The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care.

Assessment
An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well. For example, a nurse’s assessment of a hospitalized patient in pain includes not only the physical causes and manifestations of pain, but the patient’s response—an inability to get out of bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or request for more pain mediation.

Diagnosis
The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example, respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan.

Outcomes / Planning
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses as well as other health professionals caring for the patient have access to it.

Implementation
Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s record.

Evaluation
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.

Focus on your audience and narrow your topic. 

Editor’s note: Dissemination 101 is a series designed to help nurses share their expertise. To read other articles in the series, visit myamericannurse.com/category/dissemination-101. 

Takeaways:

• Writing for publication allows you to contribute to nursing practice and help build nursing and healthcare knowledge.
• Taking a step-by-step approach to writing a clinical article can help increase the chances for acceptance.

Are you thinking about writing a clinical article for publication? You can write for a general interest nursing journal that addresses a broad audience or a specialty journal that caters to nurses focused on caring for a specific patient population (for example, oncology or wound care). Most clinical articles published in general interest journals aim to help nurses understand the clinical presentation and progression of a disease or health issue and the subsequent care for a specific patient population.

To increase your chances of article acceptance for publication, take a step-by-step approach, as recommended by Mee.

Start with what you know

Write about what you’re most familiar with. Are you working on a hemodialysis unit and recently managed a patient who experienced a cardiovascular event? Then consider writing about managing cardiovascular emergencies in this patient population. Are you an endoscopy nurse who works with patients receiving endoscopic retrograde cho­lan­giopancreatography? Focus your article on the nursing implications of caring for patients after this test.

Strive to keep your topic focused so you can control manuscript length and ensure you deliver relevant content to the reader. For example, an article about caring for patients with pancreatic disorders is too broad. A narrower-focus article might cover cystic fibrosis, specifically on the impact of this condition on health-related quality of life. You can narrow the topic further by a concentrating on adolescents.

Solo vs. team writing

Are you going to write alone or with a team? Pros and cons exist for each. When writing alone, you may have better control of your timeline and content. However, compared to writing with a team, you might miss an opportunity to present a more diverse perspective of the topic. Another advantage of writing with a team includes having more access to resources, including a network of colleagues to interview. With a team, you can distribute the work among the authors and even have more proofreaders. However, delays may arise if one team member lags behind schedule or conflict emerges within the group. When writing with a team, establish authorship early in the process. The International Committee of Medical Journal Editors developed a set of four criteria to establish authorship: authors should make substantial contributions to the manuscript, draft or revise it, have final approval of the published version, and agree to be accountable for all aspects of the work.

Journal selection

Before selecting a journal, establish your intended audience. For example, are you writing for staff nurses, clinical nurse specialists, nurse practitioners, or nurse midwives? Write for the selected audience, keeping in mind what they already know about the topic.

Now you can narrow your journal choices to those that are a good match for your topic and intended audience. You can expect immediate rejection if your manuscript doesn’t match a journal’s purpose and readership. Read at least three to four issues, and explore the table of contents for similar articles related to your topic. An article on a disease or condition similar to your topic doesn’t necessarily make yours ineligible for publication. Your topic may have a different focus.

After you select the target journal, carefully read the author guidelines, which usually can be found on the journal’s website. Follow directions for formatting the manuscript, and comply with page or word limitations. Consider querying the journal editor before submitting your manuscript (in fact, many journals require this step). Querying can help ensure your topic is appropriate for the journal. In addition, the editor may provide feedback to help you focus the manuscript accordingly before submission.

Article type

The various formats of clinical articles include case studies, how-to articles, and clinical reviews. (See Elements of a clinical review article).

Elements of a clinical review article

Clinical review articles typically include the following sections:

• Etiology. The cause or origin of the disease.
• Pathophysiology. The pathologic and physiologic processes associated with the disease.
• Epidemiology. Discussion of disease frequency (number of new cases in a given population) or prevalence (number of cases present at a point in time).
• Clinical presentation. What are the signs and symptoms of the disease?
• Diagnostics. This includes relevant tests and normal and abnormal laboratory values.
• Treatment and interventions. Depending on the journal guidelines, this section might include medications, medical and nursing procedures, and key nursing considerations.
• Patient education. This section focuses on key points for patient education. If your article discusses best practices in your setting, consider including a patient education handout that can be incorporated into any organization.
• Nursing implications. Includes the nursing process from assessment to interventions and outcomes. Some journals want a separate section devoted to nursing implications.

Case studies 

Most nurses are familiar with case studies, first from learning how to write them in nursing school and then in clinical practice when reading progress notes. If you’re a novice writer, you’ll find reading case studies in journals to be helpful.

Published case studies can evolve from real case reports or be a simulated, fictional case. If you choose to write about a real case, obtain permission from the patient and your organization. Although the patient’s identity will be concealed in your article, you may run the risk of readers identifying the patient. Also, don’t choose a case that’s so rare that the reader may never encounter such a situation.

Case studies typically begin with the patient’s health history followed by a discussion of the common clinical presentation, pathophysiology, nursing process, psychosocial considerations, and treatments. Keep in mind that you’re using the case to teach readers, not merely reporting what you experienced.

How-to articles 

How-to articles focus on teaching a skill, procedure, or intervention. For example, caring for patients with a colostomy, proning patients with COVID-19 who haven’t been intubated, or attending to patients after cardiac catheterization. When writing a how-to article, focus on what’s most meaningful to nurses who provide direct care, such as patient and family education, and cite evidence-based recommendations.

Do your research

A fundamental motto for writing is “Read. Read. Read. Write. Write. Write.” In other words, do your research. When you read a wide range of literature on your topic, including relevant nursing models or theories, and access key databases, you’ll soon be ready to write. Organize your notes (paper or digital) and maintain a complete and accurate account of your references, which should be as current as possible.

Create an outline

Use an outline to organize your thoughts and help you stick to one main focus or purpose that’s appropriate for the intended audience. At this stage, you’ll also want to consider what information can be best covered in tables or figures rather than in text. For example, you can create a table that lists signs and symptoms in column one and related pathophysiology in column two. Such a table can effectively present a large amount of information that doesn’t need to be repeated in the text of the article.

Writing and editing

Knowing where to start can be daunting. Consider starting on the section you know best or one for which you have the most information to help build your confidence and spur development of other sections. Other writing tips that can enhance the chances your article will be accepted for publication and engage readers include the following:

• Use active voice. Writing in an active voice helps to clarify and simplify your writing for readers. Avoid complicated sentence structures.
  • Passive: The patient’s medications were reviewed by the nurse before discharge.
  • Active: The nurse reviewed the medications with the patient before discharge.
• Cite relevant references. Support statistics and practice guidelines with appropriate recent references. Follow the journal’s author guidelines for number of references and style.

After completing your manuscript, let a day or two pass and then read it again and start editing. Note that your overall goal during editing is to make the manuscript concise and meaningful for the reader. Check that it aligns with the journal’s author guidelines and requirements. Ask colleagues (including an expert, novice, or someone who’s not familiar with your topic) to read your manuscript, and request their honest feedback. Review tables, figures, and other graphics to ensure they provide relevant information and that they adhere to the journal’s author guidelines. Consider including a box with key points, such as nursing implications.

Submission

Follow the journal’s article submission guidelines. Some journals request submission through an author portal that requires you to create an author account, while others prefer to receive submissions via email. Most journals require that you attach a cover letter, sign copyright release and conflict-of-interest forms, and submit information about all authors.

Advance nursing practice and science

When you publish, you contribute to nursing practice and help build nursing and healthcare knowledge by providing guidance for practitioners and future researchers. Regardless of the type of article, include implications for nursing practice and, when appropriate, education, policy, and research. Writing involves hard work, but it’s rewarding and a great way to build your credentials.

Rhoda Redulla is director of nursing excellence and Magnet Recognition at NewYork-Presbyterian in New York, New York, associate editor of Gastroenterology Nursing Journal, and author of Fast Facts for Making the Most of Your Career in Nursing. 

References

Eldh AC, Almost J, DeCorby-Watson K, et al Clinical interventions, implementation interventions, and the potential greyness in between – a discussion paper. BMC Health Serv Res. 2017;17(1):16. doi:10.1186/s12913-016-1958-5

International Committee of Medical Journal Editors. Defining the role of authors and contributors.

Mee C. Writing the clinical article. In: Saver C ed. Anatomy of Writing for Publication for Nurses. 4th ed. Indianapolis, IN: Sigma; 2021.

Morton P, Ketefian S, Redman R. Writing the research report. In: Saver C, ed. Anatomy of Writing for Publication for Nurses. 4th ed. Indianapolis, IN: Sigma; 2021.

Oermann MH, Ingles TM. Writing manuscripts about quality improvement: Squire 2.0 and beyond. Health. April 30, 2019.

Roush K. What types of articles to write. Am J Nurs. 2017;117(5):68-71. doi:10.1097/01.NAJ.0000516278.97098.02

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